Harm reduction in practice – The Community Oriented Substance Use Programme in Tshwane

Scheibe, Andrew; Shelly, Shaun; Hugo, Jannie; Mohale, Matilda; Lalla, Sasha; Renkin, Wayne; Gloeck, Natasha; Khambule, Senzo; Kroukamp, Lorinda; Bhoora, Urvisha; Marcus, Tessa S.

doi:10.4102/phcfm.v12i1.2285

Cited by 25 publications

(40 citation statements)

References 12 publications

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“…Collectively they combine years of clinical experience and expertise in providing generalist integrated community-oriented primary care [7]. They also are involved in best practice harm reduction and substance use management through the Community Oriented Substance Use Programme (COSUP) [8] implemented with the City of Tshwane Metropolitan Municipality and Gauteng Department of Health's Tshwane District (South Africa). During the first COVID-19 daily meetings (23)(24)(25)(26) March 2020) the team identified seven priorities for action ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Harm reduction in an emergency response to homelessness during South Africa’s COVID-19 lockdown

et al. 2020

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Background: Caledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane, was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided by the University of Pretoria's Department of Family Medicine between 24 March and 6 April 2020. Methods: This study uses a narrative approach to restory situated, transient, partial and provisional knowledge. Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of selected healthcare first responders directly involved in the shelter. Results: The impending lockdown generated intense interactions by UP-DFM to prepare for the provision of COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian residents. Conclusion: The Caledonian shelter is an account of organisational resilience in the face of homelessness and substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and the imperative of including OST in essential primary healthcare.

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Section: Introductionmentioning

confidence: 99%

Harm reduction in an emergency response to homelessness during South Africa’s COVID-19 lockdown

et al. 2020

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“…Twelve included drop-in centres that provided access to ablution facilities, nutrition, computers, other psychosocial services and safe spaces to socialise. 18 Community Oriented Substance Use Progamme was considered more suitable as it is a harm reduction-based organisation that offers Opioid Substitute Therapy (OST) and Needle Exchange Programme (NSP) across CoT.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Community Oriented Substance Use Programme (COSUP), which is implemented by the University of Pretoria, Department of Family Medicine, and funded by the City of Tshwane Municipality (CoT), is the first publicly funded communitybased programmatic response to the use of unregulated drugs in SA. 18 Based on the connection between HIV risk behaviour and drug use, it can be justified that strengthening efforts to offer integrated HIV harm reduction and SUD treatment services should be prioritised. Although the drafting of SA's Third National Drug Master Plan (2013-2017) gave eminence to the necessity of addressing drug abuse as part of comprehensive HIV prevention efforts, programmes targeting people who use drugs, with a sole purpose of addressing drug use and sexual risk behaviour in SA, are scarce.…”

Section: Introductionmentioning

confidence: 99%

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A plea of those who are affected most by HIV: The utterances by women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng

Lefoka

Netangaheni

2021

Afr. j. prim. health care fam. med.

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Background: Nyaope injecting practice brought the field of Human Immunodeficiency Virus (HIV) prevention and Substance Use Disorder (SUD) together. It is complex and requires multidisciplinary approach. Women who use drugs face individual, social, and structural factors that fuel their vulnerability to contract HIV, and other blood-borne infections. Women Who Inject Drugs (WWID) are a subpopulation that is neglected from HIV prevention and SUD treatment interventions, and are hardly the subject of surveys. In order to fully address the HIV epidemic among WWID it is imperative that they become part of the process of finding solutions.Aim: This study explored the strategies to curb HIV incidence among Women Who Inject Nyaope (WWIN), residing in City of Tshwane Municipality, Gauteng Province.Setting: The research was conducted within COSUP. COSUP was considered more appropriate as it is a harm reduction based organisation.Methods: The study utilised the qualitative research approach. Semi structured interviews were conducted with 24 women with a history of injecting Nyaope aged between 19 to 35 years. The data was analysed using thematic data analysis.Results: Health intervention, economic intervention and educational intervention was stressed as key strategies to curb HIV among WWIN. Needle exchange programmes, condom distribution, PrEP, HIV Testing and Counselling, employment opportunities, support groups and awareness campaigns if implemented, can yield positive outcomes in curbing HIV among WWID.Conclusion: Mechanisms to curb HIV among WWIN exist, and when implemented, they have the potential to address high HIV incidence among women who inject Nyaope.

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“…[7] The programme follows a harm-reduction approach, offering OST, as well as psychosocial support and needle syringe programmes to outpatients at 17 different sites around the city. [8] Sites are situated in the inner city of Tshwane, as well as in surrounding suburban and periurban areas. OST offered to those with an OUD primarily includes methadone (~80%).…”

Section: Researchmentioning

confidence: 99%

Factors predicting 6-month retention among people with opioid use disorders accessing outpatient methadone maintenance therapy in Tshwane, South Africa

et al. 2020

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Harm reduction in practice – The Community Oriented Substance Use Programme in Tshwane

Cited by 25 publications

References 12 publications

Harm reduction in an emergency response to homelessness during South Africa’s COVID-19 lockdown

Harm reduction in an emergency response to homelessness during South Africa’s COVID-19 lockdown

A plea of those who are affected most by HIV: The utterances by women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng

Factors predicting 6-month retention among people with opioid use disorders accessing outpatient methadone maintenance therapy in Tshwane, South Africa

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